Lymphadenectomy in ovarian cancer

Current guidelines for the surgical staging of ovarian cancer include the removal of retroperitoneal lymph nodes (pelvic and aortic). In most centres this is achieved by means of laparotomy, but advanced laparoscopic techniques have also been performed and still further prospective controlled studies with long-term follow-up are necessary to validate the efficacy. Lymph node sampling, short of complete dissection, should be avoided because it may be insufficient to detect metastasis. In any case, laparoscopic lymphadenectomy as well as open surgery, should be in the hands of properly trained subspecialists in gynaecologic oncology. Of 97 patients with ovarian carcinoma studied in our hospital, 68% were treated by means of complete staging laparotomy (FIGO). Lymphadenectomy was spared in 14 cases with stage I tumours (mainly serous) without changes in overall survival. In 15% metastases in pelvic lymph nodes were present. In the same proportion aortic lymph nodes were positive. In 5.5%, aortic metastases were present in the absence of pelvic involvement.